Paediatrics and Geriatrics
PHTLS Lecture Notes
These notes are designed to be used to accompany the
standard PHTLS slides for the 30 minute Paediatric and
Geriatric Trauma course.
The time under each section title is the time at
which that section should be starting
Introduction
0:00
- Slide: Review objectives [12.2]
- Summarise: look at what makes young and old
different from us, and what to do about it.
- Slide: Life Span Development [12.3]
- Summarise -- states the obvious. Note terms:
kids are pre-puberty, middle age is 50-65, elderly
usually 65+.
- Slide: Concerns in Common [12.4]
- Paed airways are more fragile, geriatrics often have
respiratory problems, and both are vulnerable to shock
(small buffer)
- Slide: Trauma in children [12.5]
- Skip over
Scenario 1
3:00
- Slide: Scenario [12.6]
- Read scenario. Ask about particular concerns
given the age.
- Slide: Assessment [12.7]
- Go through points. Note especial value of any
bystanders as regards accurate history, and is Mom
around?
- Slide: Findings [12.8]
- Go through findings and ask for indications of
each one. Note child's extra vulnerability to
hypothermia and cooling effect of dampness.
Airway partial blockage, possible early shock,
possible head injury indicated.
Paediatric Trauma
7:00
- Slide: Discussion of paed trauma [12.9]
- Summarise slide
- Slide: Mechanisms in children [12.10]
- Note age ranges: older children will be
more prone to get hit by vehicles.
- Slide: Kinematics in kids [12.11]
- Bones are more elastic and so won't break
as easily, but organs are closer together so
multisystem trauma is the rule rather than exception.
- Slide: Airway, Breathing in kids [12.12]
- Note changes in head-neutral from babies (pad shoulders)
to adults (pad head) -- look in babies' mouths and all
you see is tongue!
- Slide: Circulation in kids [12.13]
- Big bleeds kill kids pretty near immediately.
For slower bleeds, early signs are subtle, and
they "crash" suddenly.
- Slide: Disability in kids [12.14]
- Younger they are, the harder to assess LOC.
Use mom if she's around; if she goes and kid
stays quiet, be scared.
- Slide: Hypothermia in kids [12.15]
- Keep 'em warm from the outset.
Trauma in Elderly
15:00
- Slide: Trauma in elderly [12.16]
- Skip over
- Slide: Geriatric trauma[12.17]
- Again, falls and vehicles major trauma deaths.
Note rising percentage of geriatric population.
Scenario 1
17:00
- Slide: Scenario [12.18]
- Describe scenario, elicit comments. Note how
helpful a baseline of woman's previous condition would be.
Actions should include insulation against cold.
- Slide: Findings [12.19]
- Run through findings. Ask for previous conditions
that could explain symptoms.
ABC in the Elderly
22:00
- Slide: Airway, Breathing changes with age [12.20]
- Note consequences of these for tolerance to injury.
- Slide: Circulation in the elderly [12.21]
- Note high incidence of varicose veins.
- Slide: Disabilities in the elderly [12.22]
- Get suggestions for how these disabilities
affect us in doing surveys.
- Slide: Pitfalls with elderly [12.23]
- Summarise: we often don't know what we're dealing
with, and they're more vulnerable than younger patients.
Summary
28:00
- Slide: Managing paeds and elderly [12.24]
- Same protocol, but know what age changes
and be more alert for sudden change.
- Slide: Summary [12.25]
- Read off slide.
- Take questions
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